Late termination of pregnancy for lethal fetal anomalies: a national survey of maternal-fetal medicine specialists.

Objective: The objective was to ascertain the practices and opinions of US maternal-fetal medicine specialists regarding termination of pregnancy as a management option following late diagnosis of lethal fetal anomalies.

Study Design: We conducted a cross-sectional mail survey of all US members of the Society of Maternal Fetal Medicine to ascertain how they manage pregnancies diagnosed with lethal fetal anomalies after 24 weeks of gestation. We analyzed the proportion of respondents that discuss termination of pregnancy as a management option, barriers to offering or accessing late termination services, and respondents' opinions about what anomalies are lethal and when pregnancy termination should be permitted.

Reduction of elective inductions in a large community hospital.

Objective: Our goal was to lower unplanned primary cesarean deliveries by reducing elective inductions.

Study Design: To implement and sustain an induction management program, a committee of care providers reviewed induction rates. "Elective" and other categories were defined.

A prospective analysis of recreational physical activity and preeclampsia risk.

Purpose: Although literature suggests that physical activity may reduce preeclampsia risk, most prior studies have relied on retrospective exposure assessment. We aimed to assess prospectively the relation between recreational physical activity before and during pregnancy and risk of preeclampsia.

Methods: We used data from a 1996-2003 cohort study of 2241 pregnant western Washington State residents.

Pregnancy loss rates after midtrimester amniocentesis.

Objective: The purpose of this study was to quantify the contemporary procedure-related loss rate after midtrimester amniocentesis using a database generated from patients who were recruited to the First And Second Trimester Evaluation of Risk for Aneuploidy trial.

Methods: A total of 35,003 unselected patients from the general population with viable singleton pregnancies were enrolled in the First And Second Trimester Evaluation of Risk for Aneuploidy trial between 10 3/7 and 13 6/7 weeks gestation and followed up prospectively for complete pregnancy outcome information. Patients who either did (study group, n=3,096) or did not (control group, n=31,907) undergo midtrimester amniocentesis were identified from the database.

Maternal asthma and risk of preeclampsia: a case-control study.

Objective: To quantify the associations between asthma characteristics and the risk of preeclampsia.

Study Design: In this case-control study, asthma history among 286 preeclampsia cases and 470 normotensive controls in Seattle was assessed by postpartum interview and medical record abstraction. OR and 95% CI were estimated using logistic regression.

Early access to prenatal care: implications for racial disparity in perinatal mortality.

Objective: To investigate racial disparities in perinatal mortality in women with early access to prenatal care.

Methods: A prospectively collected database from a large, multicenter investigation of singleton pregnancies, the FASTER trial, was queried. Patients were recruited from an unselected obstetric population between 1999 and 2002.

Risk of preeclampsia in relation to maternal history of migraine headaches.

Objective: We examined the relationship between migraines and preeclampsia risk.

Study Design: Cases were 244 women with preeclampsia and controls were 470 normotensive women. Women were asked if a physician had ever told them that they had migraines.

Assisted reproductive technology and pregnancy outcome.

Objective: To determine whether the use of assisted reproductive technology (ART) is associated with an increase in chromosomal abnormalities, fetal malformations, or adverse pregnancy outcomes.

Methods: A prospective database from a large multicenter investigation of singleton pregnancies, the First And Second Trimester Evaluation of Risk trial, was examined. Subjects were divided into 3 groups: no ART use, use of ovulation induction (with or without intrauterine insemination), and use of in vitro fertilization (IVF).

Early pregnancy lipid concentrations and the risk of gestational diabetes mellitus.

The objective of this study was to determine if early pregnancy maternal plasma lipid concentrations are elevated in women who later developed gestational diabetes mellitus (GDM) as compared with women who do not. Women, recruited prior to 16 weeks gestation, were followed until delivery. Maternal plasma lipid concentrations were measured in samples collected at 13 weeks gestation on average.

Quad screen as a predictor of adverse pregnancy outcome.

Objective: To estimate the effect of second-trimester levels of maternal serum alpha-fetoprotein (AFP), human chorionic gonadotrophin (hCG), unconjugated estriol (uE3), and inhibin A (the quad screen) on obstetric complications by using a large, prospectively collected database (the FASTER database).

Methods: The FASTER trial was a multicenter study that evaluated first- and second-trimester screening programs for aneuploidy in women with singleton pregnancies. As part of this trial, patients had a quad screen drawn at 15-18 6/7 weeks.

Cesarean delivery after elective induction in nulliparous women: the physician effect.

Objective: The purpose of this study was to assess the contribution of the individual physician to the probability of cesarean delivery among nulliparous women who undergo elective induction.

Study Design: A cohort study compared spontaneous labor and elective induction for all term, singleton, and cephalic nulliparous gestations over 2 years (1999-2000) at a large metropolitan hospital (n = 3215). Bivariate analysis was used to identify significant variables that were related to cesarean delivery.

Maternal plasma concentrations of insulinlike growth factor-1 and insulinlike growth factor-binding protein-1 in early pregnancy and subsequent risk of preeclampsia.

Objectives: We investigated the relationship between maternal plasma free insulinlike growth factor-1 (IGF-1) and insulinlike growth factor-binding protein-1 (IGFBP-1) concentrations and risk of preeclampsia.

Design And Methods: Maternal blood samples were collected at 13 weeks' gestation on average. From the cohort, we selected 53 women who developed preeclampsia and 477 who remained normotensive.

A prospective study of maternal serum C-reactive protein (CRP) concentrations and risk of gestational diabetes mellitus.

Low-grade systemic inflammation is associated with an increased risk of type 2 diabetes mellitus. Limited available data suggest inflammatory factors are predictive of gestational diabetes (GDM), a condition that is biochemically similar to type 2 diabetes. We examined the association between C-reactive protein (CRP) and GDM risk.

Maternal plasma ascorbic Acid (vitamin C) and risk of gestational diabetes mellitus.

Background: Antioxidants, particularly vitamin C (ascorbic acid), have the capacity to influence glucose tolerance. Modification of diet could reduce the likelihood of developing gestational diabetes mellitus.

Methods: In a prospective cohort study of pregnant women, we studied the association of maternal plasma ascorbic acid concentrations, measured at an average of 13 weeks' gestation, with subsequent risk of gestational diabetes.

Maternal plasma lipid concentrations in early pregnancy and risk of preeclampsia.

Background: We investigated the relationship between early pregnancy plasma lipid concentrations and risk of preeclampsia.

Methods: In a prospective cohort study, maternal blood samples were collected at an average of 13 weeks gestation. From the cohort, we selected 57 women who developed preeclampsia and 510 who remained normotensive and served as control subjects.

Maternal birth weight in relation to plasma lipid concentrations in early pregnancy.

Objective: The purpose of this study was to determine the extent to which, if at all, maternal weight at birth is related to dyslipidemia during early pregnancy, which is a risk factor for preeclampsia.

Study Design: This hospital-based prospective cohort study included 1000 women who initiated prenatal care before 16 weeks of gestation. Participants provided information about their birth weight and other sociodemographic and reproductive covariates.

Vitamin C and the risk of gestational diabetes mellitus: a case-control study.

Objective: To examine whether low maternal dietary intake of vitamin C and low maternal plasma ascorbic acid (AA) concentrations are associated with an increased risk of gestational diabetes mellitus (GDM).

Methods: Cases were 67 women with GDM meeting National Diabetes Data Group criteria. Controls were 260 women without such a diagnosis.

Plasma adiponectin concentrations in early pregnancy and subsequent risk of gestational diabetes mellitus.

Low plasma adiponectin has been identified as a risk factor for type 2 diabetes. Our objective was to determine the extent to which low maternal plasma adiponectin is predictive of gestational diabetes mellitus (GDM), a condition that is biochemically and epidemiologically similar to type 2 diabetes. We used a prospective, nested case-control study design to compare maternal plasma adiponectin concentrations in 41 cases with 70 controls.

Correlation of second-trimester sonographic and biochemical markers.

Objectives: To investigate correlations between sonographic soft markers and biochemical markers (human chorionic gonadotrophin, alpha-fetoprotein, and estriol) for Down syndrome in the second trimester of pregnancy.

Methods: A total of 2183 women with apparently normal singleton fetuses who underwent second-trimester sonography (14-22 weeks) and maternal serum biochemical testing (triple test) were identified. Seven sonographic markers were recorded: nuchal fold thickness, humerus length, femur length, renal pyelectasis, hyperechoic bowel, echogenic intracardiac focus, and choroid plexus cysts.

Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy.

Physical activity has been associated with a reduced risk of gestational diabetes mellitus, but inferences have been hampered by recall and selection bias. The authors examined the relation between recreational physical activity before and during pregnancy and risk of gestational diabetes mellitus in a prospective cohort study. In 1996-2000, 909 normotensive, nondiabetic women in Seattle and Tacoma, Washington, were questioned during early gestation about physical activity performed during the year before and 7 days prior to the interview during pregnancy.

Increased maternal plasma leptin in early pregnancy and risk of gestational diabetes mellitus.

Objective: Emerging evidence suggests that leptin, an adipocyte-derived hormone, may have independent direct effects on both insulin secretion and action, in addition to its well documented effects on appetite and energy expenditure. Some, but not all, previously published studies suggest that maternal leptin concentrations may be increased in pregnancies complicated by gestational diabetes mellitus (GDM). We examined the association between plasma leptin concentration and GDM risk.

A prospective study of maternal serum C-reactive protein concentrations and risk of preeclampsia.

Background: We measured C-reactive protein (CRP), a clinical marker of systemic inflammation, in maternal serum collected at 13 weeks gestation on average, to determine whether elevations precede the clinical manifestation of preeclampsia.

Methods: Using a prospective, nested, case-control study design we measured CRP concentrations using a competitive immunoassay in 60 women who developed preeclampsia and in 506 women who remained normotensive throughout pregnancy. Logistic regression procedures were used to calculate odds ratio (OR) and 95% CI.

Familial aggregation of type 2 diabetes and chronic hypertension in women with gestational diabetes mellitus.

Objective: To perform a case-control study to assess the extent to which women with a positive parental history of type 2 diabetes and/or chronic hypertension experienced an increased risk of developing gestational diabetes mellitus (GDM).

Study Design: Participants (133 GDM cases and 373 controls) provided information on first-degree family history of the 2 conditions and other covariates of interest in interviews. Logistic regression procedures were used to derive odds ratios and 95% confidence intervals adjusted for confounding by maternal age, race/ethnicity and prepregnancy adiposity.

Weight at birth and subsequent risk of preeclampsia as an adult.

Objective: We examined the influence of maternal birth weight on the risk of the development of preeclampsia, a likely precursor to adult chronic disease.

Study Design: This hospital-based case-control study included 181 preeclampsia cases and 349 control subjects. Participants provided information about their birth weight and other covariates that included medical and reproductive history, prepregnancy weight, and adult height.

History of abortion and subsequent risk of preeclampsia.

Objective: To examine the effect of abortion type, number and timing on risk of preeclampsia in subsequent pregnancies.

Study Design: We conducted a hospital-based, case-control study in Seattle and Tacoma, Washington, between 1998 and 2001. Preeclampsia cases (n = 199) and controls (n = 383) provided detailed information regarding their pregnancy histories and other covariates, such as prepregnancy weight and adult height.